Recurrent vulvovaginal candidiasis associated with the use of a probiotic supplement

Abstract

Background: Recurrent vulvovaginal candidiasis (RVVC) is a common cause of morbidity in women with vulvovaginal complaints. Saccharomyces species have been shown to cause vulvovaginal candidiasis in only 2 % - 6 % of RVVC cases. However, these infections are often resistant to typical medication regimens, resulting in treatment failure and recurrence. Exogenous exposure to S. cerevisiae has been shown to result in vaginitis and other secondary infections in patients who consume probiotics with these organisms have been reported. Because of this, caution has been advised regarding the inclusion of S. cerevisiae in supplements.

Case: We present a case of a postmenopausal woman with RVVC caused by Saccharomyces cerevisiae while consuming a daily probiotic supplement comprised of Saccharomyces species. We further describe symptomatic and biologic cure with intravaginal boric acid in a rare cause of vaginitis with sparse literature on treatment recommendations.

Conclusions: Probiotic supplements containing S. cerevisiae have been implicated in systemic infection, and exogenous exposure to S. cerevisiae has been linked to vulvovaginal candidiasis. Little is known about the potential adverse effects of probiotic supplements containing Saccharomyces species in women with compromised vaginal microbiomes, and further study and caution may be warranted. Intravaginal boric acid should be considered in the treatment of S. cerevisiae vaginitis.

Keywords: Adverse effects; Boric acid; Postmenopausal; Probiotics; RVVC; Saccharomyces cerevisiae; Secondary infection.